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PSYCHOANALYTIC PSYCHOLOGY, 72(1), 127-140

Copyright © 1995, Lawrence Eribaum Associates, Inc.

CONTRIBUTIONS TO PSYCHOANALYTIC
PSYCHOTHERAPY

'Interpreting in the Dark": Race and


Ethnicity in Psychoanalytic
Psychotherapy

Kimberlyn Leary, PhD


University of Michigan

In this article, I discuss the impact of race and ethnicity on the psychotherapeu-
tic process of three patients in psychoanalytic psychotherapy with an African
American therapist. The influence of race on the treatment process has been
explored infrequently in psychoanalytic writing, despite consensus that it is
conceptually and clinically relevant. This outcome stems from the complex web
of attitudes attending talk about race in this country. Race and ethnicity remain
topics that engender anxiety in social and clinical discourse. I selectively and
critically review the psychoanalytic literature on race, which has been ham-
pered by incomplete conceptualizations and overgeneralizations that often limit
its clinical utility. I then explore, through clinical examples, the way in which
attention directed at racial issues provided a framework for the treatment
alliance and illuminated key transferences and resistances for these patients.
Discussion of racial issues is most fruitful when racial themes are situated in
bodily and social contexts and when the meaning that race has within the
therapy dyad is negotiated by patient and therapist, apart from idealized or
socially correct conceptualizations from outside of the treatment situation.

In this article, I discuss the impact of race and ethnicity on the psychothera-
peutic process and the development of meanings associated with race for

Requests for reprints should be sent to Kimberlyn Leary, PhD, University of Michigan, 527
East Liberty Street, Suite 209D, Ann Arbor, MI 48104.
128 LEARY

three patients in psychoanalytic psychotherapy with an African Ameri ;an


therapist. I begin with a brief critical review of the psychoanalytic litera ure
on race. I then illustrate, through the use of case examples, the way in wl ici
the therapist's race provided a framework for the treatment alliance ind
illuminated transferences central to the personality dynamics of each pati< nl.
The case material focuses on the technical interventions that either fac ili-
tated or hindered the emergence of racial themes and the range of dyna: lie
issues associated with their presence.
The role that race and ethnicity play in the psychoanalytic treatm ;nt
process has been discussed infrequently in psychoanalytic writing des] ite
broad consensus that this issue is both conceptually and clinically relev; nt.
The reasons for what might be termed the only "occasional interest" (M in-
day, 1992) of psychoanalytic theorists in the topic of race are many. In
contemporary America, a complex web of attitudes surrounds talk about r ce
and ethnicity. Despite its democratic ideals, the United States continues to be
a highly "racialized" society (cf. Morrison, 1992)—that is, a culture whi se
very existence is intertwined with the politics of immigration, integrati in
and the assimilation of many diverse peoples.
In most instances, race and ethnicity remain topics that are treated as
taboo in both social and clinical practice. Discussion about race is eitl er
avoided altogether (as, e.g., when every pertinent detail about a patient is
presented in a case conference except his or her racial background or si in
color) or quickly dispensed with after only superficial consideration a id
with a sigh of relief. More than talk about sex or even money, talk about n ;e
and ethnicity tends to engender anxiety.
The sensitivities associated with discussions of race are, in part, rooted in
historical practices. In this country, race and ethnic origin have been t le
occasion for exclusion and marginalization, with slavery representing t le
extreme of disenfranchisement. Conversely, and more recently, race a id
ethnic background have also been the basis for particular kinds of recogi i-
tion and redress, as through programs of affirmative action.
The importance of race and ethnicity in psychological life is furfh 2r
underscored by its necessary connection with the body. To talk about ra :e
and ethnicity involves immersion, however temporary, in a body who ;e
sight, texture, and even smell may be alike or dissimilar from one's ow i.
Thus, talk about race can arouse powerful affects and key human concerns- —
among them, the problem of difference, wishes for recognition, and desir :s
for domination and control (cf. Holmes, 1992; W. Myers, 1977).
Though psychoanalytic authors have recognized the import of race n
human psychology, psychoanalytic accounts of the impact of race on tl e
treatment process—in the main—have been hampered by incomplete co i-
ceptualizations and overgeneralizations that limit the usefulness of the r
findings. In her review of the psychoanalytic literature on race ar d
ethnicity, Munday (1992) detailed a number of early investigations th it
centered on Black analysands in treatment with White analysts (Adam ;,
RACE AND ETHNICITY 1 29

1950;Curry, 1964; Kennedy, 1952).


In general, race was viewed as something of an interference in the treat-
ment process. For example, the Black patient's race as well as the potentially
prejudicial attitudes of White analysts were viewed as obstacles to conduct-
ing successful treatments. As an illustration, Kennedy (1952) suggested that
Black patients enter treatment already fearing and distrusting White thera-
pists because of specific prior life experiences. As a corrective, she argued
that the Black patient acquire an ego ideal not predicated on skin color to
participate fully in treatment and to accept the White therapist as a col-
league.
Such an approach is, of course, problematic in the view of contemporary
eyes. In effect, Kennedy (1952) enjoins the Black patient to resolve whatever
complicated experience of Whites she has to make her treatment a success.
Here, the Black patient is put in the curious position of needing to cure
herself before the treatment may take place.
Additional difficulties surface in other early analytic formulations of race
and treatment process. Holmes (1992) noted that in many of these early
discussions, the impact of race and ethnicity was often narrowed to an
inquiry concerning the influence of racism on personality development and
interpersonal dynamics. In these accounts, clinical attention was directed at
the truncated experiences of self and other that result from the Black
patient's membership in a stigmatized social group (Munday, 1992).
For instance, Kardiner and Ovesey (1951) and Karon (1958), among
others, offered descriptions of the "negro personality." The personality func-
tioning of Black people living under segregation and with discrimination
was said to be typified by a constellation of traits, including low self-esteem,
apathy, fears of relatedness, mistrust, problems with the control of aggres-
sion, and an orientation to pleasure in the moment. Existing differences
between Blacks and Whites in such things as values, preferences, and family
dynamics were assumed to be symptomatic accommodations to racism and
to reflect compensatory efforts to cope with feelings of inferiority and
self-hate. Gardner (1971), Jones (1985), and others cautioned that the find-
ings from these investigations are limited because of a wide array of meth-
odological difficulties, including experimenter effects and samples that
incompletely represented the populations under study. In these conceptual-
izations, the cultural practices of Black patients do not have any independent
status in their own right, apart from reflecting personality deficits.
The effect of many of these early analytic authors is that the Black
analysand is portrayed as someone distinctly different from the White thera-
pist. The Black patient is portrayed as an enigmatic "other, " an unfamiliar
alien. Given the tenor of the times—many of these articles were published
before the mid-1960s—these clinical reports document the often problem-
atic though well-intentioned efforts of analysts who struggled to make the
alien stranger known. Making the other familiar most often meant rendering
all that typified Blacks as alien—namely skin color and cultural back-
130 LEARY

ground—assimilable to psychoanalytic structures of meaning. Sterba (19< 7),


for example, observed through his analytic work with White patients hat
rejection of Blacks by the majority culture is based on repressed sib: ing
rivalry because Blacks are equated with unwanted younger siblings. Bla< ks,
reconfigured in the terms of analytic discourse, were rendered well knc wn
and no longer foreigners, even though it seems likely that many Bla ;ks
would no longer recognize themselves.
With the advent of widespread integration in the 1960s, later anal; tic
articles highlighted the impact of race and ethnicity in treatment dyad; in
which the therapist was Black (Curry, 1964; Gardner, 1971; Schactei &
Butts, 1968). The Black therapist was held to be a novelty for White ; ncl
Black patient alike. Curry (1964), for example, highlighted the importa ce
of the patient's communications about the therapist's race. Curry viev eel
discussions of the Black therapist's race as a preview to the patient's h ter
transferences and cautioned against confusing racial responses with he
transference. Instead, Curry viewed the patient's comments about he
therapist's Blackness as "mythological responses" that reflect the residue of
fairy tales, children's stories, and other cultural artifacts that deal with, or
example, "devils and darkness." According to Curry, these reactions sh; pe
the transference but do not constitute it.
For this idea to work, a patient's stereotyped notions of the Bh ;k
therapist's race—for example, that his Blackness mirrors his wickedness— -is
understood to convey something that is necessarily true about Blackness a id
not to communicate something that is necessarily true of the patient, cc n-
structed by her in accord with her own wishes and needs. Under these terr s,
skin color, hair texture, and body shape are treated as having specific a pri. >ri
meanings. Race is treated as a "content" whose symbolic meaning is alrea ly
established. With such a conceptualization, the therapist does not set out to
learn about the patient's experience of race but looks at the patient's encoi n-
ter with racial meanings that appear to have an autonomous life of their ow n.
In my view, this way of thinking represents a peculiar distortion of analy ic
work. Such a perspective emphasizes static, reified meanings and not t le
fluid productions of a treatment process involving the elaboration of psycr ic
reality and idiosyncratic fantasy.
Schacter and Butts (1968) were among the first to discuss the inadequacy )f
traditional psychoanalytic theory to account for the impact of race on t le
treatment process. Instead of viewing racial differences as necessarily limiti .g
and constraining, they argued that clinical attention to racial issues could ha re
a "catalytic" effect and mobilize the treatment process. Similarly, Gardn jr
(1971) discussed the impact of mixed-race and same-race therapy dyads, ei I-
phasizing the way in which patient and therapist expectancies about race ai d
ethnicity could, when understood, enhance effective therapy process.
The findings of these authors (i.e., Gardner, 1971; Schacter & Buti;,
1968) foreshadowed contemporary observations that suggest that clinic il
attention directed toward the realities and fantasies associated with race nu y
RACE AND ETHNICITY 1 31

facilitate psychotherapeutic work or even be a precondition for its success,


especially in mixed-race therapy dyads and in psychotherapies where patient
and therapist share minority status (see also Fischer, 1971; Griffith, 1977;
Holmes, 1992; W. Myers, 1977).
Other analytic clinicians also advocate discussing racial themes and issue
whenever and with whomever they emerge, including treatments where both
patient and therapist are White because race, ethnicity, and skin color remain of
pivotal importance in both social and psychological life (cf. Calnek, 1970;
Holmes, 1992). In our increasingly pluralistic society, both minority and major-
ity patients are more likely to have transactions with those from a variety of
ethnic backgrounds in face-to-face exchanges as well as through the media and
popular culture. Critical aspects of these real and fantasies encounters are, of
course, internalized and form a backdrop against which any number of dynamic
issues may be brought to life. Holmes (1992), for instance, argued that the
analysis of racial issues may even provide a critical point of contact with the
patient's core transferences, conflicts and resistances.
Despite consensus among most psychoanalytic clinicians as to the import-
ance of attending to race as a ubiquitous carrier of crucial meanings, psycho-
analytic accounts of race and ethnicity have remained incomplete and
limited to the "occasional theorizing" of only a few clinicians. Psychody-
namic authors who have directed themselves to the relative dearth of ana-
lytic writing on racial and ethnic issues suggest that less clinical attention
has been directed to racial issues because patients and therapists of color are
themselves underrepresented in the population offering and receiving psy-
chodynamic treatment. According to this perspective, the dynamics of race
and ethnicity remain unarticulated because most therapists are unfamiliar
with the clinical issues such patients present.
This explanation, however accurate in terms of statistical representation,
seems once again to obscure more central issues. Such a perspective appears
to conceptualize race and ethnicity as a kind of local geography, vital to the
journey if you happen to be in the area but only a passing curiosity, at best,
to those from other locales. Discussions of this sort treat race and ethnicity
as if they were qualities possessed only by people of color and ignore the fact
that White patients also have a race and an ethnicity.
As this brief survey of the literature illustrates, race, like gender, contin-
ues to be an especially vexing problem within psychoanalytic theory. The
persistent difficulties analytic authors encounter when discussing race have
led some clinical practitioners to suggest that psychoanalytic models are
inappropriate ones for Black patients (cf. Ivey, Ivey, & Simek-Morgan,
1993). These clinicians question the relevance of a "Eurocentric" paradigm
developed in the 19th century for the struggles faced by contemporary
African American in a racialized society, despite evidence that Black and
White patients appear to benefit about equally from psychodynamic therapy
in either racially similar or dissimilar dyads (Jones, 1982).
As a solution, it has been suggested that African American patients would
132 LEARY

be better served through the provision of culturally specific psychothen py


(cf. Sue, 1987). "Afrocentric" psychotherapies, for example, rest on he
premise that traditional psychotherapy models are not effective for Afrii an
Americans (L. Myers, 1988). These models reconfigure psychotherapy to
include treatment techniques, usually cognitive-behavioral, believed to be
consonant with the cultural practices and beliefs of African American p o-
ples (e.g. egalitarian labor and group decision making rather than reliance an
a single expert). In addition, many of these approaches also emphasize he
values of cultural affiliation and identification. Consequently, Afrocent ic
perspectives offer new norms for the behavior, health, and pathology of
African Americans apart from those provided by the majority culture.
Although these models offer the potential of reaching underserved poj u-
lations and may, in instances, make treatment more accessible to those w 10
might otherwise reject it—and are valuable in that respect—in my view, th iy
also raise troubling new concerns. Among them is the way in which the se
models offer, in effect, "a new psychology" for African Americans a id
provide standards for a racialized identity. There is the danger that specil y-
ing the rules for racial identity inadvertently serves to minimize the indiv: i-
uality of African Americans in contemporary America (see also, Jom s,
1985). Further, these approaches also appear to extend a bias encountered n
early psychoanalytic formulations of the role of race.
Early analytic writing and Afrocentric revisions converge on the beli ;f
that the Black patient must be set apart to be understood. Both of the ;e
perspectives abrogate the notion that race and ethnicity can be discussed n
a "shareable" world in which Blacks and Whites may have different poir :s
of view about themselves and each other but still create meaningful unds r -
standings in ways that maintain the personal integrity of each.
The assertion that psychoanalytic formulations fail to appreciate the exp :-
rience of African American patients rests on historical accounts of particul ir
psychoanalytic treatments that were themselves riddled with theoretical ai d
clinical difficulties. The incomplete conceptualizations of these earlier ps -
choanalytic writers speaks to the necessity for developing new theory, but c o
not, as I see it and as a matter of course, require a move to a new conceptu tl
neighborhood.
Psychoanalytic treatment itself has undergone something of a revolutic n
as of late. New approaches to jpsychoanalytic process emphasize the way : n
which the analytic encounter is profoundly relational. Meaning is not som< -
thing that is exclusively discovered or encountered. In certain respect ,
analytic reality is now understood by many to be jointly constructed an i
negotiated by the analytic partners themselves (Goldberg, 1987; Hoffmai ,
1983; Renik, 1993). Recognition of the importance of interaction and th ;
ubiquity of enactments in the clinical situation may generate new ways c f
articulating the complexity of clinical transactions as they relate to race an 1
ethnicity. In fact, the psychoanalytic situation may offer a unique opporti -
nity for elaborating the meaning of race and ethnicity to the extent that th ;
RACE AND ETHNICITY 1 33

analytic clinician can focus on the amalgams of fantasy and reality to which
talk about race is heir and discover the idiosyncratic purposes to which it has
been put.
The following clinical material illustrates some of the difficulties inherent
in this kind of work as well as the potential benefits. The clinical approach
presented here extends the work of Holmes (1992) in discussing how race
may function as a vehicle through which core developmental issues, key
transferences, and related countertransferences may be transported to the
clinical situation. How that vehicle may be driven or be halted in its tracks
is the topic that will be considered next.

CASE ILLUSTRATION 1:
LEARNING FROM ERRORS

In the first case, I describe a series of moments in the psychotherapy of a


child during which race was of particular significance. The case was my first
child treatment, conducted when I was a trainee in supervision with a senior
colleague. In this vignette, I first discuss how a particular countertransfer-
ence and collegia] discussions, emphasizing the social reality of race, led to
an error in technique.
My patient was a 7-year-old, White boy whom I will call Michael. Mi-
chael, a sturdy, blonde, blue-eyed boy, was an appealing youngster with the
ready ability to engage adults quickly. Treatment had been sought for his
encopresis. At school, his symptoms resulted in him being teased and ostra-
cized by his classmates. At home, he denied his soiling, despite the evidence
of his stained pants and the unmistakable odor. On at least one occasion,
Michael father's confronted him with his soiling by abruptly pulling down
Michael's pants, deeply humiliating the boy. His increasingly uncooperative
attitude at home brought further censure: His father spanked him with an
open hand or with a belt for infractions the parents deemed most serious.
Michael took to the therapy quickly. He was able to verbalize his feelings
and enter actively into imaginative play; early on, he invited me to be a
participant. Michael's interest in my race came to life near the end of the first
year of treatment. During one session, I noted that Michael seemed unusu-
ally preoccupied with a drawing he was making of a superhero, commenting
often and anxiously on the colors he was choosing. When I commented on
how interested he seemed to be in people's colors, he turned to me, studied
my face, and asked, "Are you Black or White?" I asked what he thought. He
considered me judiciously and said, "I think you are tan." I agreed that my
color was tan but that I was Black. Michael's ensuing silence promoted me
to comment that he seemed worried about my being Black. Michael re-
sponded by holding his arm up to mine and announcing, "You're not that
Black." I commented that his worry about my race was so big that he wanted
to pretend I wasn't Black. Michael responded by replying that there were
134 LEARY

slaves when his dad was a boy. I agreed there were slaves but not when lis
dad was a boy. Michael insisted otherwise saying, "There are slaves eve y-
where." This time I assented and invited him to say more, but he said no
more about Blacks or slaves during the remainder of the session.
At the next appointment, Michael began by reciting the colors of he
American flag, chanting "red, white and blue" over and over again. I sai i 1
thought Michael was reminding us of the important talk we'd had abi ut
people's colors. Michael then proposed that we play a game he cal 3d
"slave." I immediately noted to myself that I felt some uneasiness with t lis
game, but I consented. I was instructed that I was the slave and Michael, i :ie
boss. My discomfort increased as the patient, enacting the part of a ruthli ss
master, demanded a series of increasingly impossible tasks. Michael as i le
master pretended to beat me with an imaginary whip. The young patie it,
standing over me, was breathless after his exertions. I learned from him tl at
slaves had to go to sleep early, attend school, and were compelled to co n-
plete "stupid" chores. In short, in Michael's world, slaves were equivalent to
children. I could then communicate how scared, little, and humiliated
"slaves" could feel and how much they would rather be like power ul
"master" parents so as not to feel so small and ashamed and to exact th •ir
revenge.
In discussion of these hours with my senior colleague, I commented >n
my discomfort with my patient's slave game, especially the relish with whi ;h
he seemed to enjoy being my master. Before supervision, I felt vagut ly
troubled about how all this would appear to an onlooker. My colleag le
echoed my anxiety. Concern was expressed about the consequences of 1 t-
ting Michael continue in this vein. Both my supervisor and I were quick to
note how stimulated Michael appeared at the end of the session, discuss :d
how burdensome feeling that powerful had been to him, and were worri :d
about the impact of his treating me in a degrading and demeaning mann :r.
The supervisor suggested, and I agreed, that as the treatment rules includ :d
the provision that no one got hurt, and because in the slave game the sla 'e
got "hurt," that this game would come to an end. It was agreed that I wot Id
tell Michael that even though the game would stop, he and I could still U Ik
about slave and master feelings.
When I suggested this to Michael, he nodded gravely. And though he la' ;r
listened thoughtfully to me talk about master and slave feelings, never age in
did he speak of slaves directly, even though these themes permeated \ is
material through other venues.
In this series of interactions, I believe that an error occurred: Talk a id
actions connected with the topic of race were met with an overemphasis in
reality. I responded to the patient's announcement that I was tan with a
reality: Though tan, I was "Black." Although accurate, this young patien 's
reluctance to conclude that 1 was Eilack went unaddressed, even thou ;h
Michael himself had raised the question of whether I was Black or White. A
similar misstep was narrowly averted when I attempted again to correel a
RACE AND ETHNICITY 1 35

misperception—namely that there were no slaves when the patient's father


was a boy. The patient's persistence and my ultimate acceptance of this led
to the slave game. This game quite clearly provided a forum for the child to
bring to life his own humiliating powerlessness and efforts to protect himself
by identifying with the master aggressor. My supervisor and I, however,
responded as though I were actually being enslaved and were, in fact, facing
real degradation that required intervention. Clearly, this was not so. Further,
I believe that my supervisor and I extended our discomfort and feelings of
being overstimulated to the child; we felt they were causing difficulty for
him alone when these feelings seemed to permeate both the clinical and
supervisory situations. Would a therapist and supervisor have been so con-
cerned if the therapist were White and the patient Black? Would the patient
have been asked, in effect, to surrender his game if his slave therapist had
been White? I suspect not. I believe his game would have remained the
fantasy expression of the child's conflicts and concerns that it was. Instead,
the game became a vehicle for the clinicians' conflicts and concerns. The
social reality of race, especially ongoing discomfort in this culture with the
historical fact of slavery, interrupted both clinicians' ability to attend to and
live with the patient's psychic reality.

CASE ILLUSTRATION 2: NEGOTIATING RACE

In the following vignette, my race was dealt with differently. The patient and
I were able to use my race as a stepping stone to important transferences and
to build useful understandings. Mr. A., a 25-year-old gay White man, pre-
sented for treatment with concerns about his inability to make long-term
commitments to romantic partners or to enjoy comfortable friendships with
either men or women. In most encounters, he flaunted his considerable
intellectual talents and was caustic and cutting. Following such self-dis-
plays, Mr. A. suffered enormous anxiety. Now desperately contrite, he
awaited castigation. Over time, we came to understand that his driven need
to force himself on others and the punishment he expected in return were
connected to important early experiences with his mother. The ritual of
exposing himself to an expected retaliatory attack reflected, in part, Mr. A.'s
rather profound anxieties about his maleness, which he dealt with coun-
terphobically. While growing up, he had felt painfully excluded by his
mother, the provocative autocratic authority of the family home who favored
his younger sisters. Mr. A.'s posturing with friends and colleagues showed
his efforts to affirm his worth as a male but also brought with them the fear
that such exposure would result in damage and humiliating loss.
Mr. A. made a number of references to race and ethnic background during
the early months of his therapy. During one session, he expressed near
outrage when a college acquaintance invited him to attend a synagogue
service where she was to be the cantor. As we explored this, it became clear
136 LEARY

that Mr, A. was nearly beside himself with envy and rage because his fri ;nd
had so easily assumed that he would want to watch her perform. Mr. A. ra led
against this woman's supposed view of herself as special and unique, wl ich
he came to link—tentatively at first-—with her being a Jew, one of the
"chosen people." In the same session, he lacerated Black students at a 1( cal
college whom he believed had been offered admission because of affirma ive
action. I was able to speak to how outraged Mr. A. felt that Jews and Bte :ks
could so easily allow themselves to be "chosen" and "affirmed" when for his
part, Mr. A. felt so unclaimed, so ill-considered, and so uncomfort; ble
because of the danger he associated with standing out himself.
With some hesitation, Mr. A. began to refer more specifically to my r; ce.
At the time, he viewed me as a wild and provocative woman, similar to his
mother. For example, when I shifted my leg, Mr. A. wondered if it migh be
a seductive invitation. When I moved my hand, Mr. A. reported his expe> ta-
tion that I planned to scratch my crotch in his presence. My race becarr s a
mechanism for greater elaboration of these ideas when Mr. A. found him: elf
alternately fascinated and repelled by my hair. When I responded with :he
request that he tell what he saw and imagined, he initially limited himsel to
a reality, saying "You have a lot of hair." Emboldened by this, he went 01 to
say that my hair was not only big, but untamed, wild, and bushy. Further, he
thought I wore it with abandon. Additional associations included his vi ;w
that my hair was like a lion's mane and compared my hair to that of
Medusa—full of snakes. He also thought with some amusement that my w ild
hair reminded him of his mother's pantyhose drawer, entangled and o\ sr
flowing. When I noted that it is the male lion who has a mane, we be ter
understood his experience of my hair: For Mr. A., my hair was experiem eel
as a provocative appropriation of what belonged to men, and to himself in
particular. This reflected his view that his mother's power in his family \ as
acquired by dint of disarming men of what was rightfully theirs.
During another session, Mr. A. mentioned, with a great deal of embarra ;s-
ment, that he had experienced a "racist" thought: As children, he and lis,
sisters had mimicked Black English to tease and amuse one another. I as! eri
him to tell me about it. Instead of describing his memory, to our mut lal
surprise, Mr. A. began to speak in a high strung approximation of Bh ck
English in a southern dialect. Mr. A. immediately felt ashamed and out ol
control. He had the sudden wish that I would respond in kind and speak in
Black English with him. When I again invited him to say more, he s. id
perhaps I had spoken this way before I went to college and graduate scho )1,
when I was a girl at home. I asked him about Black girls who spoke with h m
like this. He told me that he had known few Black people closely, but so ne
Black kids had been bussed to his school. He remembered that a loud gro jp
of Black girls had "adopted" him in junior high. He thinks they were troub e-
makers, but they called him "sweetheart" and playfully teased him about'. is
"skinny White-boy ass." Mr. A. had felt secretly flattered by their attentic ns
and covertly enjoyed being singled out. Reflecting on this memory, I si g-
RACE AND ETHNICITY 137

gested to Mr. A. that his use of Black English and desire for me to respond
in kind reflected a wish that we could be Black girls together. I suggested
that he felt that if we could both be Black girls together, then we could also
be provocative and not worry about getting into trouble. I also said that I
thought he felt that if we were both Black girls together, we could appreciate
the attributes that White boys had and what they could offer, in a way he felt
his mother had not been able to do for him. With this, we were able to
explore in sharper relief his long, frustrated wish to be admired and cher-
ished for his differences, including his maleness.
With this patient, race and ethnic background provided a fertile soil in
which important transferences could germinate. This was so, I believe, to the
extent that patient and therapist could negotiate what meaning race was to
have within the dyad. Negotiations of this sort are by no means limited to
talk about race and ethnicity but define the framework of all dynamic
understanding (cf. Goldberg, 1987). In these interactions, for example, atten-
tion to the range of meanings the patient attached to Blackness (e.g., the
freedom to be affirmed and provocative and to comfortably draw attention to
one's self) as well as establishing the bodily context of race and ethnicity
(i.e., my hair and the Black girls' playful comments about his "White-boy
ass") contributed to understanding the patient's unique concerns and idio-
syncratic psychology. Again, such negotiations stand in counterdistinction to
the social realities of race to which patient, therapist, or both may be bound
outside of the consulting room.

CASE ILLUSTRATION 3: RACE AND


RESISTANCE

In the next case, a clinic's decision to assign an African Amercian patient to


an African American therapist emerged as a formidable resistance to the
development of a treatment alliance. Ms. B., a single African American
medical student, sought therapy with the complaint that she felt isolated in
her program "with no one to talk to" in a meaningful way about her experi-
ence. During the consultation phase, Ms. B. and the consulting therapist
came to frame Ms. B.'s concerns in racialized terms: As Ms. B. was an
African American woman, a significant part of her distress was understood
to be centered on Ms. B.'s experience on being a minority in a majority
culture, ambivalent about her presence. The consulting therapist was aware
that there was more to Ms. B.'s story—for example, Ms. B.'s upper-income
professional family, private education, and successful tenure at an Ivy
League college made her feelings of estrangement something more than
being an outsider in an unfamiliar environment alone. Indeed, as Ms. B. was
quick to acknowledge, at her new university she was, in fact, an insider in
circumstances very familiar to her. Nevertheless, in consultation with senior
colleagues, the consulting therapist and Ms. B. decided that the patient's
138 LEARY

treatment needs would be best served by assignment to a Black thera] ist.


This was so, although Ms. B. neither made this request nor independe nly
indicated a preference for a minority therapist, though she accepted the
consulting therapist's referral to a Black therapist in apparent agreemem
In the early sessions, Ms. B. greeted the transfer with a bemused but
resentful detachment that came to be her signature for the tenure of the
treatment. She explained her feelings of alienation within her program s a
consequence of the bureaucratic structure of the university, which she fe.t
did not take "individual circumstances into account." At one level, his
functioned as a commentary on Ms. B.'s lifelong complaint that her perse nal
needs were ignored because of her developmentally disabled your ger
brother, whom she guiltily and bitterly resented for absorbing her pare its'
attention and the family's resources.
On another level, it soon became clear that Ms. B.'s reproach was direc ted
at the clinic and reflected her ambivalent feelings about being assigned o a
Black therapist. Ms. B. had responded to the fact of her Black therapist as
she had coped with pressures in her family, by manifestly meeting ler
obligations. She attended her sessions faithfully, but I also felt the treatm ;nt
was oddly silent despite Ms. B.'s evident willingness to speak of her ife
experience. In response to my queries about her feelings about seein ; a
Black therapist, Ms. B. enthusiastically stated that she couldn't speak ope Uy
with a White doctor, though it was soon became apparent that neither co lid
she tell her Black therapist what was on her mind. Once again, and now in
the transference, Ms. B. felt she had no one with whom she could talk ab sut
her experience.
I believe that Ms. B.'s assignment to a Black therapist—and the assur ip-
tion that Ms. B. would be more comfortable with this arrangement thoi gh
she made no such request herself—became a major obstacle to Ms. I ,'s
developing a tenable treatment alliance. This was so, in part, because he
clinic's decision to assign her to a Black therapist echoed the backst; ge
maneuvering she felt had characterized her parents' efforts to manage th ;ir
disabled younger child whose disability was often described euphemistica l>
and not directly acknowledged, despite its obvious presence.
In time, Ms. B. also revealed additional constraints on her treatm n(
imposed by the tacit assumption that her therapeutic work would be > n-
hanced if she were seen by a minority therapist. Through her criticism o ' a
Black professor at her undergraduate college whose racial views did not fit
comfortably with those of Black student organizations on campus, we ca ne
to learn about her transference fear that a Black therapist would find Ms. 1 ,'s
own ideas about race objectionable. With recognition of this, Ms. B. v as
able to discuss, albeit in only a limited way, the many difficulties she r id
encountered with the Black men she had chosen for romantic partners. S le
was also able to allude to heir sexual attraction for White male colleagu :s,
which she felt might bring censure from other Blacks, including from 1 le
therapist. In fact, Ms. B.'s attraction to White men appeared to be one of 1 le
RACE AND ETHNICITY 139

issues about which she felt she had no one with whom she could openly talk.
Over time, Ms. B. and I were able to piece together some understanding of
her reactions toward the unilateral decision to assign her to a Black therapist,
though this remained an issue about which the patient could not speak openly
and which I believe resulted in a genuine therapeutic process remaining just
out of reach.

CONCLUSIONS

This small sample of case illustrations documents what I believe to be the


clinical utility of directing attention to the emergence of racial themes that
occur in the course of treatment. This is so in mixed-race therapy dyads,
where patient and therapist share minority status, and in treatments where
both therapist and patient are White. Race and ethnicity represent amalgams
of reality and fantasy that lend themselves to psychoanalytic scrutiny, but
cultural prohibitions and ego ideals make counterreactions at the level of the
clinician and the clinical institution quite likely, and even inevitable. Discus-
sion of racial issues is furthered when the bodily as well as the social-histor-
ical context of these meanings is elaborated. This is best realized when
patients and therapists can negotiate the meanings that race and ethnicity are
to have within the dyad rather than conform to idealized and socially correct
conceptualizations that issue from outside the treatment situation.

ACKNOWLEDGMENT

Earlier versions of this article were presented at the Duke University Psy-
chology Colloquium in February 1993 and as part of the Race and Ethnicity
in Psychoanalytic Psychotherapy panel at the April 1992 meeting of the
American Psychological Association, Division 39, in Philadelphia.

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